? Pancreatitis Assistance

[Amanda and Button]

Hi all,

Button's Snap FPL came back abnormal, possibly indicating Pancreatitis. I have been reading as much information I can about this and asked to get Button on Cerenia to help with nausea. My vet told me that this should also help with abdominal pain so we did not get her on any other pain medications. She is already receiving fluid therapy. The food and medications she is on currently are listed in my signature. If anyone has experience balancing the needs of Pancreatitis with Diabetes and Chronic Renal Failure, please let me know if you can think of anything else I should be talking to my vet about or researching. I will be seeing my vet today and asking about a Spec FPL test (to get more detailed results) and whether an ultrasound would tell us anything more. I want to find out more about B12 injections and how we can tell if Button needs these. Also, I'm not sure how to tell how high her phosphorus levels are, but I know Fancy Feast Classic is not great for its phosphorus content. If anyone knows of a food that is high in protein, low in carbs, fat and phosphorus I am all ears. Her main problem right now is abdominal discomfort and she is not able to process her food well resulting in alternating constipation and diarrhea. We have started her on a product called Little Remedies - Gas Relief Drops for the extra gas in her digestive tract and this seems to have helped somewhat with regulating her bowel movements. My vet recommended Miralax for constipation. I have not tried this yet, but have it at the house now.

Thank you in advance!
Amanda and Button

Earlier post on Button:
http://www.felinediabetes.com/FDMB/threads/meet-button.169333/
http://www.felinediabetes.com/FDMB/threads/meet-button.169333/
Button's SS attached

 

[Critter Mom]

** LONG POST ALERT **

Hi Amanda,

I'm really sorry to hear about Button having pancreatitis.

I have been reading as much information I can about this and asked to get Button on Cerenia to help with nausea. My vet told me that this should also help with abdominal pain so we did not get her on any other pain medications.

These are excellent resources:

Nausea and appetite issues - symptoms and treatments (great for learning how to determine which foods cause least upset)

IDEXX pancreatitis treatment guidelines (very informative and comprehensive)

Cerenia exerts only a very mild analgesic effect. If abdominal/back pain is present then buprenorphine is recommended.

Get a course of B12 injections by default (see IDEXX guidelines). B12 can really give a kitty a boost from the first dose. It helps with nutrient absorption, and may also help with appetite and exert some anti-inflammatory effect.

IBD Kitties - B12 info

Links to food lists can be found in this thread (including FD friendly foods with lower phosphorus). Feeding more frequent, smaller meals can help reduce nausea and discomfort.
Timed feeders are an absolute godsend!

Adding a little water to each meal can improve hydration. Proper hydration is key to making a pancreatitis kitty more comfortable.

Some cats appear to be more fat-intolerant than others.

Any dietary / supplement changes are better introduced s-l-o-w-l-y.

Pancreatitis will possibly exert the strongest influence on food choices; sometimes we're forced to accept that the right food is the one our kitty can actually eat regularly and reliably. If you can find a diabetic friendly food which agrees with Button it will deal with both issues. Otherwise insulin can be worked around higher carb loads. Re the CKD, in early stage renal insufficiency diabetic friendly choices should be OK. Vets may insist that low protein diets are better but in early stage CKD higher protein content tends to be better since it lessens issued with muscle wastage, a common problem in CKD cats at later stages). If you can't find a low phos food which agrees with Button you can elect to use a phosphorus binder. More about this at Tanya's Site:

http://www.felinecrf.org/phosphorus_binders.htm
Phosphorus binders may be constipating and constipation may exacerbate chronic pancreatitis symptoms. Stool consistency can be improved by adding fibre to the diet (e.g. plain canned pumpkin) or using a stool softener such as Miralax. More info on feline constipation here:

www.felineconstipation.org

Adding fibre to the diet can help with both constipation and diarrhoea. You need to make sure the cat isn't backed up before adding fibre to the diet (else it's like building up pressure behind a dam and could lead to further - potentially serious - problems.) Another thing to look at is slippery elm bark. While not as effective as allopathic meds in the height of a flare it can help with nausea, vomiting and constipation problems. More info here:

http://www.felinecrf.org/holistic_treatments.htm#slippery_elm_bark

Note that some supportive meds may be constipating (notably ondansetron and buprenorphine) so stool frequency and consistency needs to be monitored and any issues addressed with appropriate treatment(s).

Cerenia and ondansetron are great for treating nausea if constipation is not an issue. If there is a constipation problem, treatment with metoclopramide for a day or two can help restore improved gut motility. (Note: metoclopramide is *useless* as a standalone treatment for nausea in cats because they have very few of the receptors it targets - see the IDEXX document for a discussion of this.) Ondansetron or Cerenia are highly unlikely to have any beneficial effect on nausea levels until any constipation issue is resolved.

If nausea and constipation are well-managed usually cat with chronic pancreatitis and/or CKD issues will eat fairly well but sometimes it may be necessary to introduce an appetite stimulant. I personally prefer to use cyproheptadine because it is gentle in action and doesn't stay in the system very long so it makes it much easier to match the level of appetite stimulation to the needs of the kitty at any particular time. (A tiny dose is usually good for 8-12 hours and it can be given up to 3 times daily.) One caveat: cyproheptadine is an antihistamine and therefore may raise blood pressure. A BP check at the vets is advisable before giving this med. Side effects may include drowsiness (especially in cats receiving bupe for pain management) but I've found the drowsiness wears off quickly. If the dose given is a bit too much it may cause mild depressive symptoms but reducing the dose should hopefully resolve this. I've found that the right dose of cyproheptadine can actually brighten mood (the drug is sometimes used as an antidepressant in humans).

Another commonly-prescribed appy stimulant is mirtazapine. Here a small dose can stimulate appetite for 2-3 days BUT a cat may end up crazed with hunger in the early period after the dose has been administered. Some cats get on well with mirtazapine but it may cause a number of unpleasant side effects, e.g. excessive vocalisation, agitation, aggression, and serotonin syndrome (the latter being potentially life-threatening). It is probably inadvisable to treat with ondansetron and mirtazapine because when used in combination they may lead to an increased risk of the cat developing serotonin syndrome. (FYI the 'antidote' used to treat serotonin syndrome is cyproheptadine.)

Addition of a liver support supplement (e.g. milk thistle, SAM-e) may help digestive function. See the IDEXX guide for recommendations.

Our vets prescribed a product called Nutramed for Saoirse. It contains milk thistle, boswellia (popular in Germany among humans with GI issues), and maritime pine bark. I'm not sure whether it's available in the US.

It might be a good idea to also ask your vet about whether Button might need pancreatic enzymes added to her food. (I've not used them so have no input on potential benefits to offer.)

Hope some of the above is helpful to little Button. I hope she feels better very soon.

(((Button)))




Mogs
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[Amanda and Button]

Thank you so much for all of this information! I am sorting through it now. I should also ask if anyone has tips for using auto-feeders in a multi-cat household. I have been looking at the auto-feeders but have concerns over the other cats getting Button's food. I can lock her in a separate room to get her used to the feeder, but she understandably doesn't like being locked in a sick room long term.

 

[Critter Mom]

Thank you so much for all of this information!

Hard won, Amanda. Hard won.

Re the multi-cat feeding logistics I suggest posting a separate thread asking members to give you some ideas (would get more attention and - hopefully - specific answers). Pop a question mark icon next to the thread title to draw more attention to it.


Mogs
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[Critter Mom]

I will be seeing my vet today and asking about a Spec FPL test (to get more detailed results) and whether an ultrasound would tell us anything more. I want to find out more about B12 injections and how we can tell if Button needs these. Also, I'm not sure how to tell how high her phosphorus levels are, but I know

Oops! Forgot to reply to this bit.

Blood tests are needed to determine B12/folate and phosphorus levels. A full blood work up would also give information on the liver. Given its proximity to the pancreas it's a good idea to monitor function.

An abdominal ultrasound could possibly reveal more information about the status of the pancreas, liver and intestinal walls but an assessment of anaesthetic risk vs. possibly limited diagnostic benefit is advisable. If it were me I'd go for blood tests first and, depending on the results, discuss with the vet whether an ultrasound would be necessary/significantly worthwhile.


Mogs
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